Abstract
ObjectivesThe Choosing Wisely Canada (CWC) Emergency Medicine group recommends avoidance of lumbosacral radiographs for patients with non-traumatic low back pain (LBP) in the absence of red flags. The objective of this study was to evaluate imaging practices of emergency physicians (EPs) in four Calgary emergency departments (EDs) and identify patient, physician, and environmental factors associated with over-ordering of radiographs for low-risk LBP patients.MethodsData was retrospectively collected from patients, ages 18–50 and Canadian Triage and Acuity Scale (CTAS) codes 2–5, who presented with non-traumatic LBP to Calgary EDs from April 1, 2014 to March 31, 2016. Patients considered high risk, specifically with partial thromboplastin time (PTT) > 40 seconds or international normalized ratio (INR) > 1.2 seconds, any consult, admission to hospital, and history of cancer, were excluded. The primary outcome was to establish the overall usage of lumbosacral radiographs. The secondary outcome was to identify factors that influenced lumbosacral spine imaging.ResultsData from 2128 low-risk patients showed that 14.8% of the patients received lumbosacral radiographs. Variation among 132 physicians in X-ray ordering ranged from 0% to 90.9%. There were site-specific differences in ordering patterns [Rockyview General Hospital (RGH) = 21.6% > South Health Campus (SHC) = 15.6% > Peter Lougheed Centre (PLC) = 13.1% > Foothills Medical Centre (FMC) = 9.7%, p < 0.001]. Canadian College of Family Physicians-Emergency Medicine (CCFP-EM) licensed physicians ordered more X-rays compared to Fellow of the Royal College of Physicians of Canada (FRCPC) licensed physicians (16.6% vs. 11.1%, p < 0.001). Older physicians and physicians with more experience ordered more X-rays than their younger and less experienced colleagues.ConclusionConsiderable variation exists in the ordering practices of Calgary EPs. Overall, EPs seem to be choosing wisely in terms of ordering plain radiographs for non-traumatic LBP.
Highlights
Choosing Wisely Canada (CWC) is a campaign to help patients and healthcare professionals engage in conversations about unnecessary tests and treatments [1]
Data was retrospectively collected from patients, ages 18–50 and Canadian Triage and Acuity Scale (CTAS) codes 2–5, who presented with non-traumatic low back pain (LBP) to Calgary emergency departments (EDs) from April 1, 2014 to March 31, 2016
Data from 2128 low-risk patients showed that 14.8% of the patients received lumbosacral radiographs
Summary
Choosing Wisely Canada (CWC) is a campaign to help patients and healthcare professionals engage in conversations about unnecessary tests and treatments [1]. On June 2, 2015, the Canadian Association of Emergency Physicians (CAEP) established a list of five CWC recommendations that included the following recommendation: “Don’t order lumbosacral (low back) spinal imaging in patients with non-traumatic low back pain (LBP) who have no red flags/pathologic indicators.”. The CAEP has updated the list to include five more CWC recommendations for emergency department (ED) physicians [1, 2]. Back pain is one of the top 10 reasons for visit to emergency departments in Canada [4]. In 2011, more than 150,000 Canadian emergency department visits were with a chief complain of back pain [4]. The prevalence of emergency department visits due to LBP in 12 countries was estimated to be 4.4% [5]
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